Early Childhood Mental Health Consultation as Part of a Continuum of Early Childhood Mental Health Services

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Early Childhood Mental Health Consultation as
Part of a Continuum of Early Childhood Mental
Health Services

• Mary Beth Jackson
• Tal Curry

First Steps October 7, 2008
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Early Childhood Mental Health

• The social, emotional and behavioral well-being
  of young children and their families
• The developing capacity to experience, regulate,
  express emotion
• Form close, secure relationships
• Explore the environment and learn
• Adapted from ZERO TO THREE

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Why is ECMH important The view from policy

• Fits with school readiness goals
• Children who lack social and emotional skills may
  not succeed in school
• It is not cognitive or social and emotional, it
  is both
• Research suggests three pathways
• Promoting family economic security
• Ensuring quality early care and learning
  experience
• Delivering intentional social /emotional
  strategies

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The Context

• Child care providers and early childhood
  educators can foster social and emotional
  development in early childhood settings.
  (Capizzano Adams, 2003).
• However, many young children have been exhibiting
  either challenging or troubling behavior in early
  care to the point of being expelled (Gilliam
  Shahar, 2005).
• Children are
• Being kicked out of child care settings
• Struggling with the effects of violence (HS 17)
• Showing the impacts of maternal depression
• Dealing with multiple family risks (parental
  substance abuse, domestic violence and mental
  illness)

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Benefits of Intervening Early

• Early identification intervention for children
  with emotional disturbances should be promoted by
  system of care to enhance the likelihood of
  positive outcomes
• Preventive measures often reduce the impact of
  risk factors for mental health disorders and
  improve the chance for children's positive social
  and emotional development
• Early experiences can function as either risk
  factors or protective factors for a childs
  future health and development

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Benefits of Intervening Early contd

• (Zeanah, Nagle, Stafford, Rice, Farrer, 2005)
• Surgeon Generals Report, 1999
• Presidents New Freedom Commission on Mental
  Health, 2003

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Collaborative Planning for Kentuckys ECMH Program

• Started as interagency ECMH workgroup
• Developed training plan in collaboration with
  Public Health, Healthy Start
• KDE, DPH, DMHRMS, CMHCs planned developed
  logic model for statewide program
• Incorporated into KIDS NOW in fiscal year 2004

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Kentucky ECMH Program Overview

• Initiated in 2003
• Among last of program components to be added to
  KIDS Now
• Built upon existing ECMH Healthy Start in
  Childcare efforts (Healthy Childcare America
  initiative)
• Co-administered by KY DPH DMHMRS
• Contracted to 14 Regional MHMR Boards

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Funding

• Tobacco Settlement funds housed at DPH
• Majority of dollars contracted with DMHMRS
• DMHMRS subcontracts with 14 Regional MHMR Boards
  to hire ECMH Specialists
• DPH has university contracts
• EKU for evaluation and resource
• UK for training consultation
• ECCS funds used to support training and
  evaluation
• HRSA maternal depression grant will support
  training in assessment and treatment EBP through
  UL contract

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Program Implementation

• Overarching goal to build capacity across state
  to work effectively with children 0-5, and their
  families. This is done through
• Program child-level consultation to child care
  programs regarding social, emotional,
  behavioral issues,
• Training on working with young children with
  social, emotional, behavioral needs their
  families to child-serving agencies individuals,
  and
• Evaluation, assessment, therapeutic services
  for children age 0-5 their families.

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Program Implementation contd

• 1.0 FTE ECMH Specialists in regions provide
• consultation education
• assessments treatment
• community resource identification access
• training
• community planning
• supervision / case review
• Time divided between direct services, outreach,
  training, education

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ECMH Specialist Duties

• Provide
• Consultation education for child care staff
• Information resources to agencies,
  pediatricians, child-serving programs
• Training on ECMH to other MH professionals
• Assessment of children 0-5 in child care
• Referral to other services as needed
• Treatment of children 0-5 who have mental health
  needs

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ECMH Specialist Duties contd

• Collaborate with other agencies/programs serving
  children age 0-5 their families
• Assist families in accessing resources
• Foster community planning in ECMH
• Attend training on ECMH / further professional
  development
• Collect submit client and program data
• Attend quarterly meetings of all ECMH Specialists

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ECMH Clinical Program Structure

• DMHMRS funds distributed evenly across 14 CMHCs
• Each CMHC employs 1 full-time ECMH Specialist
  (see handout for job qualifications)
• Some CMHCs have divided the duties across 2 staff
• Specialist serves as regional point person on
  ECMH issues

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Each Region Differs

• Flexibility of ECMHS to meet needs of the region
• Examples
• See list of contact information for ECMHS

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ECMHS support in Natural Environment

• Child care consultations training
• Child care recommendations based on SE needs of
  the child
• Consult/attend IFSP meetings
• Linkage to natural supports such as local
  resources parenting groups, faith based
  support, etc.

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Kentucky Partnership for Families Children

• 2 statewide Early Childhood Family Liaisions
  parenting groups
• Taylor Tucker 
• Western Kentucky Parent Liaison
• taylor_tucker_at_bellsouth.net
• Nicole T. Maher
• Central Kentucky Parent Liaison 
• NicoleKPFC_at_roadrunner.com

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ECMHS Other Therapeutic Services

• Perinatal depression
• Individual family counseling
• Typically work with children 18 months and older
  diagnosis under DSM-IV-TR
• DC0-3R beginning near future in NKY
• Evidence based treatments for parent-child dyad

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Evidence Based Treatment

• Parent Child Interaction Therapy S. Eyberg
• www.pcit.org
• Child-Parent Psychotherapy A. Lieberman
• Preschool PTSD Protocol - N. Boris, C. Zeanah
• Floortime Greenspan approach
• www.floortime.org

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Evaluation Questions

• If further social emotional assessments are
  warranted, what should a primary level evaluator
  use?
• ASQSE 3mo-5.5 y/o
• Vineland 0-6y/o
• ECBI Eyberg Child Behavior Inventory
• 2y/o and up
• CBCL 18mo- 5y/o
• DECA I/T or DECA-C

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Website for further evaluations

• http//www.nectac.org/topics/menhealth/earlyid.asp
  
•  
• Compendium web address
•  

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Social Emotional Development
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Birth to 6 Months

• Emotional Development
• Communicate needs mostly through crying-May have
  rapid shifts in mood
• May show excitement by waving arms legs
• May be frightened by loud, sudden noises
• May be comforted by soothing music
• Babies as young as 4 mos. Old can be depressed.
• By 6 mos. Old, babies respond to the emotions of
  others and may be harmed socially emotionally
  by exposure to acts of violence.

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Birth to 6 Months

• Social Development
• Learn that smiling makes you smile back
• Beginnings of conversation
• Love to be held and touched
• Are not aware that others have feelings, so they
  cant think about how their behavior makes you
  feel
• Begin to realize that even though you are out of
  sight, you still exist
• Need to form strong emotional bonds with primary
  caregivers. This is vital for healthy social,
  emotional, physical, mental development.

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6 Months to 1 Year

• Emotional Development
• Are very attached to their primary caregiver
• Become anxious when the primary caregiver goes
  out of sight
• May become attached to a special blanket or toy
• Like being included in daily activities
• Show they want to be picked up by raising their
  arms or pulling on your legs
• Begin to assert their independence by refusing to
  cooperate with you

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6 Months to 1 Year

• Social Development
• Are uneasy around strangers
• Talk with babbling sounds
• Respond when called by name
• Begin to understand words such as no
• Begin to say da-da and ma-ma
• Wave bye
• Imitate other actions
• Think of other babies as objects without
  feelings, like toys

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1 to 2 Years

• Emotional Development
• May become frustrated when they cant express
  themselves as well as theyd like
• Are more demanding
• Are more independent
• Say No!
• Give hugs to show affection
• May have temper tantrums
• Tantrums typically peak in the second year
  terrible twos
• Dont stick with an activity for more than a few
  minutes

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1 to 2 Years

• Social Development
• Like to play pretend
• Are possessive of toys, too young to share
• Are more relaxed around strangers when a parent
  is present
• May be upset when a parent leaves
• Are very curious about others
• Copy the actions of nearby toddlers, but dont
  play with them
• Cannot yet understand or remember rules

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Family Risk Factors

• Maternal Depression
• Harsh Parenting
• Stressful Family Life Events
• Low Social Support
• Family Instability

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Early Predictors

• Temperamental difficulties
• Early aggression
• Language difficulties
• Noncompliance

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Warning Signs - Emotional

• Child displays little emotion
• Child is extremely fussy and difficult to soothe
• Child is extremely fearful
• Child is frequently sad

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Warning Signs Acting Out

• Child is overly active and cannot calm self
• Child is often aggressive
• Child has frequent temper tantrums

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Warning Signs - Other

• Child has sleeping and/or eating problems
• Child does not enjoy interacting with others
• Child has developmental delays

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Supplemental resources

• http//www.vanderbilt.edu/csefel/familytools/teach
  ing_emotions.pdf
•  
• CSEFEL web address (a couple of tip sheets for
  families)
•  

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For more information, contact

• Mary Beth Jackson
• 502-564-3756 ext. 3765
• Marybeth.Jackson_at_ky.gov

• Tal Curry
• 502-484-3464
• tcurry_at_northkey.org